Hyperparathyroid Flashcards
What is the major effect of parathyroid hormone, both short & long term?
Short - Helps maintain homeostasis of serum ionized calcium (increasing renal reabsorption of Ca, and phosphate excretion in urine, stimulates synthesis of Vitamin D metabolite to absorb Ca in the GI tract)
Long – Osteoclastic activity (to maintain Ca levels)
If a patient presents with muscle cramps, irritability, tetany, seizures, and parasthesias of the hands & feet, what diagnosis are you thinking?
Hypoparathyroidism
What is hypoparathyroidism and what causes it?
LOW ionized calcium, most commonly after a thyroidectomy
What can develop with hypoparathyroidism?
Chronic magnesium deficiency
What would you look for on PE for hypoparathyroidism?
Chvostek’s sign & Trousseau’s sign
Dry, thin nails, hyperactive reflexes
What would be signs & symptoms of chronic hypoparathyroidism?
Lethargy, personality changes, decreased cognitive function, cataracts
What labs would you order for hypoparathyroidism?
Total serum & ionized Ca – LOW PO4 – High Urine Ca – LOW Magnesium! ECG: Prolonged Q-T
If you see low Ca levels on lab work, what other diagnosis would you think of besides hypoparathyroidism?
Malabsorption, Vitamin D deficiency, and Hypomagnesemia
How do you treat hypoparathyroidism?
acute – IV calcium
Chronic – oral Calcium
Magnesium supplement if needed
What is the goal of treatment for hypoparathyroidism?
Maintain serum Ca in low-end of normal range
If a patient’s Ca levels come back and they are elevated what diagnosis would you think of?
Cancer, sarcoidosis, multiple myeloma, Milk-alkaline syndrome (from TUMS) and hyperparathyroidism
What is hyperparathyroidism?
Hypersectretion of PTH – most often a parathyroid adenoma
What can hyperparathyroidism lead to?
Cortical bone resorption = osteoporosis
What are the symptoms of hyperparathyroidism?
Usually none – incidental finding.
If symptoms – “moans, groans, stones, and bones” (psych, abdominal pain [pancreatitis], kidney stones, and fractures)
What can elevated calcium lead to?
fatigue, weakness, altered mental status, nausea, constipation, pancreatitis, and elevated BP
